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Meta-Analysis
. 2023 Jan 27:14:1044353.
doi: 10.3389/fimmu.2023.1044353. eCollection 2023.

Meta-analysis of neoadjuvant immunotherapy for non-metastatic colorectal cancer

Long Zhou  1 , Xiao-Quan Yang  2 , Guang-Yue Zhao  3 , Feng-Jian Wang  3 , Xin Liu  3
Affiliations
Meta-Analysis

Meta-analysis of neoadjuvant immunotherapy for non-metastatic colorectal cancer

Long Zhou et al. Front Immunol. .

Abstract

Background: Immunotherapy has been approved for the treatment of metastatic colorectal cancer. The efficacy and safety of neoadjuvant immunotherapy for the treatment of non-metastatic colorectal cancer remains unclear. We tried to explore clinical effect of neoadjuvant immunotherapy in the treatment of non-metastatic colorectal cancer.

Methods: We searched the databases (PubMed, Wanfang Embase, Cochrane Library and China National Knowledge Infrastructure databases) to obtain suitable articles up to September 2022. The primary outcomes of pathological complete response (pCRs), major pathological response (MPR), objective response rate (ORR), R0-resection and anus preserving rate were collected and evaluated. Secordary outcomes (pCRs and MPR) of subgroup analysis between deficient mismatch repair/microsatellite instability-high group (dMMR/MSI-H) and proficient mismatch repair/microsatellite stable group (pMMR/MSS) and outcomes for rectal cancer were analyzed for the final results.

Results: We included ten articles and 410 cases of non-metastatic colorectal cancer with neoadjuvant immunotherapy. There were 113 (27.5%) cases with the dMMR/MSI-H status and 167 (40.7%) cases with the pMMR/MSS status. pCRs was found in 167/373 (44.6%) patients (ES: 0.49, 95% CI: 0.36 to 0.62, P<0.01, chi2 = 65.3, P<0.01, I 2 = 86.2%) and MPR was found in 194/304 (63.8%) patients (ES: 0.66, 95% CI: 0.54 to 0.78, P<0.01, chi2 = 42.55, P<0.01, I 2 = 81.2%) with the random-effects model and huge heterogeneity. In the subgroup analysis, pCRs was higher in the dMMR/MSI-H group than the pMMR/MSS group in the fixed-effects model with minimal heterogeneity (OR: 3.55, 95% CI: 1.74 to 7.27, P<0.01, chi2 = 1.86, P=0.6, I 2 = 0%). pCRs was found in 58/172 (33.9%) rectal cancer patients (ES: 0.33, 95% CI: 0.26 to 0.40, P<0.01, chi2 = 3.04, P=0.55, I 2 = 0%) with the fixed-effects model and little heterogeneity.

Conclusion: Neoadjuvant immunotherapy could increase pCRs and MPR rate for non-metastatic colorectal cancer. Neoadjuvant immunotherapy could achieve better pCRs rate in dMMR/MSI-H group than in the pMMR/MSS group. Neoadjuvant immunotherapy could be another treatment option for non-metastatic colorectal cancer.

Systematic review registration: https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42022350523.

Keywords: dMMR/MSI-H group; meta-analysis; neoadjuvant immunotherapy; non-metastatic colorectal cancer; pMMR/MSS group.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study selection followed by PRISMA diagram.
Figure 2
Figure 2
Primary outcomes of neoadjuvant immunotherapy for non-metastatic colorectal cancer. (A) pathological complete response (pCRs); (B) major pathological response(MPR); (C) objective response rate (ORR); (D) RO-resection; (E) anus preserving rate.
Figure 3
Figure 3
Secondary outcomes of neoadjuvant immunotherapy for non-metastatic colorectal cancer. (dMMR/MSl-H vs pMMR/MSS group). (A) pathological complete response (pCRs); (B) major pathological response (MPR).
Figure 4
Figure 4
Outcomes of neoadjuvant immunotherapy for rectal cancer. (A) pathological complete response (pCRs); (B) major pathological response (MPR); (C) RO-resection; (D) Anus preserving rate.
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References

    1. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet (2019) 394(10207):1467–80. doi: 10.1016/S0140-6736(19)32319-0 - DOI - PubMed
    1. Body A, Prenen H, Lam M, Davies A, Tipping-Smith S, Lum C, et al. . Neoadjuvant therapy for locally advanced rectal cancer: Recent advances and ongoing challenges. Clin Colorectal Cancer (2021) 20(1):29–41. doi: 10.1016/j.clcc.2020.12.005 - DOI - PubMed
    1. Ominelli J, Valadão M, Araujo ROC, Cristina de Melo A, Araujo LH. The evolving field of neoadjuvant therapy in locally-advanced rectal cancer: Evidence and prospects. Clin Colorectal Cancer (2021) 20(4):288–98. doi: 10.1016/j.clcc.2021.06.005 - DOI - PubMed
    1. Li R, Wang Q, Zhang B, Yuan Y, Xie W, Huang X, et al. . Neoadjuvant chemotherapy and radiotherapy followed by resection/ablation in stage IV rectal cancer patients with potentially resectable metastases. BMC Cancer (2021) 21(1):1333. doi: 10.1186/s12885-021-09089-5 - DOI - PMC - PubMed
    1. Gosavi R, Chia C, Michael M, Heriot AG, Warrier SK, Kong JC. Neoadjuvant chemotherapy in locally advanced colon cancer: A systematic review and meta-analysis. Int J Colorectal Dis (2021) 36(10):2063–70. doi: 10.1007/s00384-021-03945-3 - DOI - PubMed

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